Ye Olde Medicine Shoppe Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHAR362 Issued in ND

Legal business name

YE OLDE MEDICINE SHOPPE INC

Doing business as

Drayton Drug

Practice address

104 E Highway 66
Drayton, ND 58225-4804

Phone

(701) 454-3831

Fax

(701) 454-3338

NPI assigned

May 25, 2010

Last updated

Oct 26, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Laurie Larson, R.PH.

Title

President

Phone

(701) 284-7676

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Drayton Drug Doing business as

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Ye Olde Medicine Shoppe

  dba Ye Olde Medicine Center

  • Community/Retail Pharmacy
  • Park River, ND
  • NPI 1720020324

  3072630235

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Ye Olde Medicine Shoppe

  dba Ye Olde Medicine Center

  • Community/Retail Pharmacy
  • Park River, ND
  • NPI 1720020324

  O20130123000480

  Same enrollment

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1790004182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E HIGHWAY 66",
            "city": "DRAYTON",
            "state": "ND",
            "postal_code": "582254804",
            "telephone_number": "701-454-3831",
            "fax_number": "701-454-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E HIGHWAY 66",
            "city": "DRAYTON",
            "state": "ND",
            "postal_code": "582254804",
            "telephone_number": "701-454-3831",
            "fax_number": "701-454-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YE OLDE MEDICINE SHOPPE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-25",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-284-7676",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ND",
            "license": "PHAR362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21549",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125584",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drayton Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Drayton Volunteer Ambulance Association
• Andrew D Duncklee, DDS
• Marlene Kay Gunderson
• Jacqueline K Hoselton
• Corey Merrill

• Community/Retail Pharmacy in Drayton, ND
• Providers in Drayton, ND by specialty
• Community/Retail Pharmacy in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.